Trigeminal neuralgia

An estimated 1 in 15,000 people have trigeminal neuralgia, also known as tic douloureux. It is usually experienced as a severe, stabbing pain to one side of the face, in the eyes, lips, nose, scalp, forehead, jaw or cheek. The pain lasts from a few seconds to a minute or two. Episodes can continue for days, weeks or months, and then disappear for months or years. While the condition is not life-threatening, it is described as among the most painful conditions known, and attacks or fear of attack can be extremely debilitating.

Trigeminal neuralgia occurs most often in people over 50, and more often in women. It may be associated with other disorders, such as multiple sclerosis. The head or face pain is presumed to be caused by a blood vessel pressing the trigeminal nerve as it exits the brainstem. Due to an inherited pattern of blood vessel formation, the condition may run in families.

Trigeminal neuralgia can take time to diagnose because there are many causes of facial pain. In some patients, trigeminal neuralgia is associated with a trigger zone, which can provide one clue for diagnosis. Rather than try to alleviate discomfort by rubbing or applying hot or cold compresses, patients who have a trigger zone tend to avoid activities that are likely to involve that area, such as shaving, biting, chewing, or face-washing.

Medications are a first-line treatment for trigeminal neuralgia, and include anticonvulsants and tricyclic antidepressants. In persistent cases, decompressive or destructive surgery may be effective.

Decompressive procedures relieve pressure on the nerve by removing the compressing blood vessel from the trigeminal nerve. Destructive procedures use heat, chemicals or radiation to produce mild damage to the nerve, decreasing or stopping the disordered nerve impulses causing the pain. However, if the pain is actually caused by trigeminal neouropathy – damage to the nerve itself – destructive procedures may actually worsen the pain.

Neurostimulation therapy may be another option for some patients, in which mild electrical current applied to nerves through a small implanted device modulates the nervous system and controls some of the painful symptoms. Trigeminal neuralgia has been treated by spinal cord stimulation, stimulation to the trigeminal nerve branch, stimulation of the hypothalamus through a deep brain implant, or stimulation of the motor cortex through electrodes placed just above the covering of the brain.

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